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COVID Community Corps Weekly Outreach Log
The COVID Community Corps Outreach Log will enable us to track the impact of your work and the entire corps. The information you share below is essential to our ability to support you in reaching New Jersey residents and accomplishing our goal of connecting with 1000 New Jersey residents a week. Please make sure to fill out the information as accurately as possible and to submit completed logs on a weekly basis.
Full Name  ✱
Date of submission ✱
(mm/dd/yyyy)
Email  ✱
If applicable, affiliated organization:
Number of people you've educated on COVID-19 and the vaccine  ✱
What feedback did you received in conversations?
Were there any consistent themes?
Number of people you’ve pre-registered for a vaccine appointment ✱
(Individuals you've registered through the NJVSS or direct booking vaccination systems)
Were there any challenges during the pre-registration process?
Number of people you’ve confirmed vaccination appointments for ✱
(Individuals who have a scheduled date/time/location for a vaccine)
Were there any challenges during the registration process?
Which municipalities are represented in your outreach efforts?  ✱
Select all that apply
c00f8e62aa01434495d5e9e4634e9211 Atlantic 
c00f8e62aa01434495d5e9e4634e9211 Bergen 
c00f8e62aa01434495d5e9e4634e9211 Burlington 
c00f8e62aa01434495d5e9e4634e9211 Camden 
c00f8e62aa01434495d5e9e4634e9211 Cape May 
c00f8e62aa01434495d5e9e4634e9211 Cumberland 
c00f8e62aa01434495d5e9e4634e9211 Essex 
c00f8e62aa01434495d5e9e4634e9211 Gloucester 
c00f8e62aa01434495d5e9e4634e9211 Hudson 
c00f8e62aa01434495d5e9e4634e9211 Hunterdon 
c00f8e62aa01434495d5e9e4634e9211 Mercer 
c00f8e62aa01434495d5e9e4634e9211 Middlesex 
c00f8e62aa01434495d5e9e4634e9211 Monmouth 
c00f8e62aa01434495d5e9e4634e9211 Morris 
c00f8e62aa01434495d5e9e4634e9211 Ocean 
c00f8e62aa01434495d5e9e4634e9211 Passaic 
c00f8e62aa01434495d5e9e4634e9211 Salem 
c00f8e62aa01434495d5e9e4634e9211 Somerset 
c00f8e62aa01434495d5e9e4634e9211 Sussex 
c00f8e62aa01434495d5e9e4634e9211 Union 
c00f8e62aa01434495d5e9e4634e9211 Warren 
Are any of the following municipalities represented in your outreach efforts? ✱
Select all that apply
c00f8e62aa01434495d5e9e4634e9211 Atlantic City 
c00f8e62aa01434495d5e9e4634e9211 Bayonne City 
c00f8e62aa01434495d5e9e4634e9211 Bridgeton City 
c00f8e62aa01434495d5e9e4634e9211 Camden City 
c00f8e62aa01434495d5e9e4634e9211 Carteret Borough 
c00f8e62aa01434495d5e9e4634e9211 City of Orange 
c00f8e62aa01434495d5e9e4634e9211 Cliffside Park Borough 
c00f8e62aa01434495d5e9e4634e9211 Dover Town 
c00f8e62aa01434495d5e9e4634e9211 East Orange City 
c00f8e62aa01434495d5e9e4634e9211 Elizabeth City 
c00f8e62aa01434495d5e9e4634e9211 Freehold Borough 
c00f8e62aa01434495d5e9e4634e9211 Guttenberg Town 
c00f8e62aa01434495d5e9e4634e9211 Hackensack City 
c00f8e62aa01434495d5e9e4634e9211 Haledon Borough 
c00f8e62aa01434495d5e9e4634e9211 Harrison Town 
c00f8e62aa01434495d5e9e4634e9211 Irvington Township 
c00f8e62aa01434495d5e9e4634e9211 Jersey City 
c00f8e62aa01434495d5e9e4634e9211 New Brunswick City 
c00f8e62aa01434495d5e9e4634e9211 Newark City 
c00f8e62aa01434495d5e9e4634e9211 North Bergen Township 
c00f8e62aa01434495d5e9e4634e9211 Passaic City 
c00f8e62aa01434495d5e9e4634e9211 Paterson City 
c00f8e62aa01434495d5e9e4634e9211 Plainfield City 
c00f8e62aa01434495d5e9e4634e9211 Pleasantville City 
c00f8e62aa01434495d5e9e4634e9211 Prospect Park Borough 
c00f8e62aa01434495d5e9e4634e9211 Red Bank Borough 
c00f8e62aa01434495d5e9e4634e9211 Trenton City 
c00f8e62aa01434495d5e9e4634e9211 Vineland City 
c00f8e62aa01434495d5e9e4634e9211 West New York Town 
c00f8e62aa01434495d5e9e4634e9211 Woodbury City 
c00f8e62aa01434495d5e9e4634e9211 None of the above 
Which vulnerable populations did you educate and engage?
71a7c25452b048ef8296e3f49c9cb1fa Black communities/African American  
71a7c25452b048ef8296e3f49c9cb1fa Hispanic/Latinx  
71a7c25452b048ef8296e3f49c9cb1fa Veterans  
71a7c25452b048ef8296e3f49c9cb1fa Homeless 
71a7c25452b048ef8296e3f49c9cb1fa Homebound  
71a7c25452b048ef8296e3f49c9cb1fa Disabled  
71a7c25452b048ef8296e3f49c9cb1fa Pregnant and nursing mothers  
71a7c25452b048ef8296e3f49c9cb1fa Tribal nations  
71a7c25452b048ef8296e3f49c9cb1fa South Asian  
71a7c25452b048ef8296e3f49c9cb1fa Orthodox Jewish  
71a7c25452b048ef8296e3f49c9cb1fa Undocumented  
71a7c25452b048ef8296e3f49c9cb1fa Migrant workers  
71a7c25452b048ef8296e3f49c9cb1fa Seniors 
71a7c25452b048ef8296e3f49c9cb1fa None of the above 
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